June 28, 2022

Cervical Cancer: It’s Not Only Preventable But Treatable

Overview

Cervical cancer is developed when the cells of the cervix (entrance to the uterus from the vagina) grow uncontrollably. Cervical cancer is a risk for all women over the age of 30. It’s the fourth most frequent cancer in women, according to statistics from Cancer.Net. Cervical cancer was diagnosed in 570,000 women worldwide in 2018, with over 311,000 women dying as a result of the disease.

The percentage of the patient survival rate after 5 years of cancer being found is 66%. Below given is the statistics of the percentage of the survival rate of the patients in different stages of cervical cancer.

Source: Cancer.Net

Signs of Cervical Cancer

First Signs of Cervical Cancer

Bloating, pelvic pain, feeling full quickly, and urinary symptoms are all common and some of the first signs of cervical cancer.

Early Signs of Cervical Cancer or Warning Signs of Cervical Cancer

Cervical cancer in the early stages or early-stage cervical cancer shows no signs or symptoms. Later stage cervical cancer is associated with the following symptoms and signs:

  • Vaginal bleeding, bleeding in between periods and after intercourse and even after menopause.
  • Watery or blood discharge with a foul smell.
  • Pain in the lower back or lower abdomen.

Main Causes and Most Common Types of Cervical Cancer

Mostly, all cases of cervical cancer are caused by Human papillomavirus (HPV), and this makes HPV the leading cause of cervical cancer or primary cause of cervical cancer. This is a type of infection that occurs to all active sexual adults in their lifetime but is mostly cleared off by the body’s immune system. However, in some individuals, the virus persists causing a few cervical cells to change into cancer cells. Other factors may include early marriage, poor genital hygiene, multiple sex partners, HIV infection, weakened immune system, multiple pregnancies, malnutrition, and even smoking.

Cervical cancer not caused by hpv – People assume that if you have HPV, you are more likely to develop cervical cancer.” However, HPV is a highly prevalent virus. Cervical cancer, on the other hand, is not.” This means if one has hpv infection does not mean cervical cancer will develop in such individuals. The truth is that having HPV does not automatically imply that you have or will develop cervical cancer. The majority of women infected with HPV do not get cervical cancer, and other risk factors such as smoking and HIV infection impact which women are more likely to acquire cervical cancer after being exposed to HPV. Patients also sometimes consider Cervicitis as Cervical Cancer. Cervicitis though is not cervical cancer, but is an inflammation of the cervix, which is the narrow, lower end of the uterus that exits into the vaginal canal. Bleeding between menstrual periods, pain during intercourse or during a pelvic exam, and abnormal vaginal discharge are all possible indications of cervicitis.

When the body’s immune system can’t get rid of oncogenic HPV strains, the infection might remain and transform normal cells into abnormal cells, eventually leading to cancer. About 10% of women who have HPV on their cervix will develop long-term HPV infections, putting them at risk for cervical cancer – hence ultimately leading to hpv turning into cancer.

There are mainly two types of cervical cancer: (1) Squamous cell carcinoma – This type of cancer begins in the thin flat outer surface of the cervix that projects into the vagina and develops from cells in the exocervix. This is the most frequent type of cervical cancer. Nine out of ten patients are diagnosed with this cancer. (2) Adenocarcinoma – This cancer develops in the transformation zone. The transformation zone is a part of the cervical canal where the exocervix joins the endocervix.

Treatment

If diagnosed in time, cervical cancer has the highest successfully treatable rate among all forms of cancer. It can be diagnosed by two main tests i.e., Pap test and HPV DNA test. If any abnormalities in these tests are found, then the doctors go for colposcopy along with the biopsy. Further radiological imaging is suggested to see the spread of the disease. Treatment of cervical cancer depends on the stage of the cancer patient. People in early stages with good general health are advised surgery where the uterus, cervix along with nearby tissues are removed (hysterectomy). People in advanced stages are treated with radiotherapy with or without chemotherapy.

The American Cancer Society Guidelines highlight important ways to prevent cervical cancer.

  • Get HPV vaccination if eligible.
  • To be tested regularly (Pap test)
  • Limit exposure to HPV
  • Safe sex / Use condom
  • Don’t smoke

New Advanced Cervical Cancer Treatment Therapies

Apart from the above main treatments, cervical cancer can also be treated by the following:

  • Targeted Therapy – This therapy targets a cancer’s specific gene, protein, or tissue environment that aids in cancer growth, halting the growth and survival of malignant cancer cells while inflicting no harm to healthy cells. When cervical cancer returns after therapy, it’s known as recurrent cancer, or when it spreads beyond the pelvis, it’s known as metastatic disease. It is treated with platinum-based chemotherapy in combination with the targeted therapy bevacizumab (Avastin). The FDA has approved two medications that are similar to bevacizumab: bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev) for the treatment of advanced cervical cancer. These are referred to as biosimilars. Apart from this, for recurrent cervical cancer treatment, FDA has also given approval to targeted therapy tisotumab vedotin (HuMax-TF).
  • Immunotherapy – Also referred to as biologic therapy, it is intended to boost the body’s natural defense system against cancer. It restores the body’s immune system function by using the material present in the body or made in the laboratory. Pembrolizumab (Keytruda), an immune checkpoint inhibitor, is administered during or after chemotherapy for cervical cancer that has progressed to other regions of the body.
  • Palliative care – Palliative care or supportive care is very important for patients with cancer. The side effects of cancer are not only physical but also emotional, social, and financial. That can be slowed, stopped, or eliminated by Palliative care.

Ongoing and Upcoming Research on Cervical Cancer

  • Research done by the University of New Mexico Health Sciences Center (https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djab173/6360464) have found that many women are screened too much for cervical cancer that might be harmful to them as too many unnecessary procedures are done. On the other hand, because of the 5-year and 3-year interval test plan, it is likely to put women at higher risk of not getting tested enough.
  • A research study by Ohio State University Wexner Medical Center.

(https://cancer.osu.edu/news/preliminary-results-of-two-large-immune-therapy-studies-show-promise-in-advanced-cervical-cancer)

Phase II clinical trials of two large Immunotherapy show promising results in advanced cervical cancer. These two studies are the largest immuno-oncology trials in relapsed cervical cancer to date, and they demonstrate that balstilimab and zalifrelimab could be a useful new therapy for cervical cancer patients.

Cervical Cancer Eradication: WHO Global Strategy

Cervical cancer is preventable and curable if detected early and effectively managed. In 2018, low- and middle-income nations accounted for about 90% of all deaths due to cervical cancer as access to public health services is limited in these countries and its screening and treatment are not extensively established. In-time screening and treatment has proved to be beneficial for the drop-in incidence rates of cervical cancer by more than 50% from the mid-1970s to the mid-2000. WHO has come up with a global strategy to accelerate the elimination of cervical cancer and to treat this cancer as a public health problem. For this, it has come up with 3 main target points to be achieved over the next decade, which would reduce new cervical cancer cases by 40% and prevent 5 million deaths by 2050. The pointers were given by WHO are as follows:

Source: WHO International News

References: 

https://www.blkmaxhospital.com/

https://www.blkmaxhospital.com/blk-blog/title/what-you-need-to-know-about-cervical-cancer

https://www.cancer.gov/

https://www.cancer.gov/types/cervical

https://www.cancer.net/cancer-types/cervical-cancer/statistics

https://www.who.int/news/item/17-11-2021-global-leaders-call-for-cervical-cancer-elimination-on-day-of-action

https://www.sciencedirect.com/

https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djab173/6360464

https://cancer.osu.edu/news/preliminary-results-of-two-large-immune-therapy-studies-show-promise-in-advanced-cervical-cancer

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